Cabergoline Timeline for Results

L

LBS

Member
Hi,

I was recommended to start this thread for my cat LB who has been on cabergoline for 7 weeks and we haven't seen any changes yet. LB is an 11 year old male and has had acromegaly disease for about 2 or 3 years. He currently needs 35 Units of insulin twice a day to keep his blood sugars in the 300s or lower. Lately he has been in the upper 300s/lower 400s when I check his sugars in the morning and at night so I may need to increase his insulin dose soon. He weighs 17 pounds. I have been giving him 0.5mls of Cabergoline 100mcg/1 ml once a day for 7 weeks. I had to research to find this medication and asked my vet to try it. She was not knowledgable of this medication so I am in control and on my own with his cabergoline. Do we think I need to increase his dose or give it twice a day? Or should I give it more time before I make changes. Any advise is welcome!

Thank you!!
McKenna and LB
 
6 weeks is usually about the timeframe it takes for most caregivers to notice some movement. Some (like my cat) are almost immediate.

The standard dose is 10mcg/kg, most people start every other day then move to daily if not seeing results. He's about 7.7kg, so you can increase up to 0.77mL (or 0.75mL if that's easier to measure). I don't know if anyone who has increased beyond 10mcg/kg, or done more often than once a day - but Wendy might.

How was he diagnosed with acro? Was he also tested for IAA? Any other conditions you're aware of?

A few things to consider -

1. If his BG is consistently 300-400, it may mean you haven't hit the right dose yet (see #2). So, you are not likely to see any effects of cabergoline in terms of BG. Had he been regulated when you started, then you may have noticed a decreased need for insulin.

2. You did not mention midcycle tests, do you ever test in the middle of the cycles or do curves? Dose is based on nadir, so if you aren't getting those tests it's possible you've passed the right dose.
 
Welcome McKenna.

Cabergoline is typically given once per day, I don't know of anyone who did it more frequently. The research says once per day. I have heard of someone increasing the dose a bit beyond 10mcg/kg, but only after having a good idea what it's doing at 10mcg/kg and monitoring blood sugar data closely. I'd start with what Melissa suggests for dose. I also agree with her comments about his insulin dose. Which insulin are you giving?
 
I brought him in to my vet for diabetic symptoms and he was originally diagnosed with Diabetes. He was started on vetsulin slowly and after we reached 10 units with no changes in blood sugars, my vet diagnosed him with Acromegaly since he had insulin resistance. This was the first cat she ever diagnosed with this disease. I do not think he was tested for IAA. The only other conditions I am aware of is that his thyroid levels have been increasing and he has been slowly losing weight, but the levels are still within a normal range so we are not treating yet. My vet said we need to watch these levels. He does not take medication for anything else. When he was originally diagnosed I would complete blood sugar curves throughout the day to monitor his sugars but once we found a dose that worked for him I stopped the curves. I only complete them if I notice him acting different with increased thirst, increased hunger, and urinating outside the litter box. Those are the cues that I would have to increase his insulin needs which happens every couple months. I noticed these cues two months ago and increased his insulin dosage by 3 units twice but saw no improvement in sugars and symptoms so I brought him to see my vet and this is when I suggested this medication. I have had a hard time managing his sugars since this incidence. I followed a dosage that someone in a cabergoline thread recommended 5mg/kg. I will try increasing his dosage to 0.75 mls.
 
My vet suggested not increasing his insulin anymore since he was not having any success with the last 2 increases I tried before bringing him in. After bringing up this medication, my vet said this can be our last effort since he was not responding to insulin anymore. She has never had a pet that needed this much insulin. And there are no other specialists around me that I could take him to. Should I try increasing his insulin again? I go through about a vial a week of insulin which has been hard to keep up with. Acromegaly kitties are expensive!!!
 
Is he still on Vetsulin? That's a horrid insulin for cats, even more so for those with acromegaly. Levemir would be a much better option. It's longer lasting and a much gentler insulin. With Vetsulin, testing just before you give insulin, with no mid cycle tests, is dangerous and tells you nothing about how the dose is doing. Especially with cabergline in the mix. Changes in dose can happen very quickly. I wouldn't depend on physical symptoms to give you clues to lower the dose. You should start getting more mid cycle tests. It'd really help us help you if you set up a bit of information for us to see. Details on the signature data and spreadsheet are in this post:
New? How You Can Help Us Help You!

Neko was the first cat my vet had that she knew of that had acromegaly. And she only found out because I insisted on getting her tested for it. Shortly after, when the vet learned what to look for, she found another in the practice. Approximately one in four diabetic cats has it, but many vets don't know that.
 
At his weight of 17 lbs. he is 7.71 kg so will need a dose of 10/mcg per milligrams. So about 77 mcg. At your strength of 100 mcg per mL, you need to give more like .75 mL on your oral syringe.
 
I would like to add that I 00 percent agree with everything the Wendy has said about insulin and testing and keeping Oreo safe. We can help you. Please do the preshot tests and get some mid cycle tests to see how low the dose is taking your Oreo. Better yet, we can help you make an insulin switch to a gentler insulin that is very beneficial for acro cats like Levemir. You can do this. We can help.
 
I do test before I give in the morning and again before at night. He is in the 300s low 400s at those times but I can for sure do a curve later this week to give you all more information. Tonight he was high at 424 before his 35 units. I unfortunately work and won't be able to curve until Thursday.

I do not think his IGF-1 was tested. Our vet just said since he was insulin resistant, he most likely has acromegaly.
 
Even without doing a formal curve, you can get valid information if you can test at 2 or 3 hours after the shot. Can you do that at night before bed? Some people get a +2 test before leaving for work. It depends on your work schedule of course.

If a cat does not have acromegaly, cabergoline won't help. There are other conditions that can cause a cat to need a higher dose. That's why we recommend getting the IGF-1 testing done before starting cabergoline.
 
LBS said:
I do test before I give in the morning and again before at night. He is in the 300s low 400s at those times but I can for sure do a curve later this week to give you all more information. Tonight he was high at 424 before his 35 units. I unfortunately work and won't be able to curve until Thursday.

I do not think his IGF-1 was tested. Our vet just said since he was insulin resistant, he most likely has acromegaly.
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Okay. I was wondering this because it sounded like no formal acromegaly testing had been done. It seems to have been based simply on insulin resistance. As Wendy said, there are other conditions such as IAA (insulin auto-antibodies) that can cause insulin resistance. It sounds also like his best dose has not been found yet. I bet you have been working very hard to help Oreo.
 
I have been working very hard and spending a fortune on him. I am a recent college graduate so this was very hard during school. But now I have a job and have more money to spend on him lol. But I guess there was no formal test done and I did not know to test before starting this medication. When he was first diagnosed I was able to manage his blood sugars pretty easily, and then a few months would go by and his sugars would spike and he would start having symptoms again. I would take him to the vet and no infections or issues could be found, and finally she said this is normal for agro cats and we would just need to increase his insulin dosage. We repeated this cycle several times until now he is up to 35 units and not responding even after I tried to increase his dosage by 3 units twice. I just checked his sugar again 2.5 hours after I gave him insulin tonight and he is at 386. Again he was 424 before his dose tonight. I will check again in the morning and will update!
 
It took six months or more to any effect of cabergoline on my Snuffles. Dose went down a little but control of BG drastically improved. I could maintain BGS below 120. He is on about 12 units dtice daily.
 
That is great to hear! Thank you for all the responses! I am home today and can do a mid cycle test later today. LB’s sugar was 415 this morning.

How would I go about changing LB’s insulin to Levemir? Do you get this at a human pharmacy? How much does it cost? I know human insulin can be crazy expensive!! Would I have to start over with a low dose slow start method to find LB’s new dosage? I just don’t think he is responding to his vetsulin anymore..
 
No you would definitely not start over. Just get as many mid cycle tests as you can and that will give us a good idea where to start.

Levemir is human pharmacies, yes. I'm assuming you're in the US? Most of us order Levemir from Marks Marine Pharmacy in Canada, it's probably cost equivalent to the Vetsulin on a per unit basis that way. Trouble may be shipping, if you're in a hot part of the US now is not the ideal time to ship, better to wait another month or so. You would also need U100 syringes.
 
Today LBs sugars barely changed even with the vetsulin. He was consistently in the 400s all day. 426 this am pre shot, 404 6 hours after shot, and 412 tonight pre shot tonight. How many mid cycles would be needed? I can start filling out the spreadsheet tomorrow.

Yes I am in the US. I would need to get a prescription for Levemir from my vet correct?
 
Yes you would need prescription from your vet (and if your vet suggests Lantus, politely decline - it has an acid base and tends to sting above about 10U, though it varies by cat).

I would do 3-4 days in a row. It's possible he is bouncing - when numbers drop lower and/or faster than they're used to, the liver perceives it as a threat and dumps stored glycogen and counterregulatory hormones in order to spike BG back up. The effects can last up to 3 days, and they stay high and flat. I'd suggest testing closer to the 4 hour mark on Vetsulin, as it tends to nadir earlier.
 
Hi everyone,

I was able to do a little digging today and found on a past vet receipt that LB was tested for his IGF-1 back in 8/2020 but cannot find the results. I will contact my vet this week asking for those results and if we can switch to Levemir. I also created my spreadsheet and plan to update it as much as possible.

Thanks for all your help!!!
 
Sounds like a good plan. Thanks for starting on the spreadsheet, it'll really help us help you. You do need to change the permission of the document so that others with the link can read it.
 
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Hi,
I got a prescription for the Levemir from my vet today. When would be the best time to order from Marks Marine Pharmacy in Canada? I live in Wisconsin, US so the temperature is still warm and im assuming the Levemir needs to be refrigerated. Do they ship it insulated so it would stay cold?
 
LBS said:
Hi,
I got a prescription for the Levemir from my vet today. When would be the best time to order from Marks Marine Pharmacy in Canada? I live in Wisconsin, US so the temperature is still warm and im assuming the Levemir needs to be refrigerated. Do they ship it insulated so it would stay cold?
Click to expand...
I live in Minnesota! I just ordered my refill of Levemir from Marks last week. You will want to order the extra styrofoam and ice packs, and they just emailed me about adding in even 2 more ice packs for $5. They are expediting my shipping at no charge. You should plan for up to 3 weeks by the time you get it as it has to pass through customs in LA. So make sure you’ve got enough of your other insulin until the Levemir comes. I switched my Howie to Levemir and am so glad I did! He doesn’t mind it at all and I was able to finally get him fairly regulated with it eventually.
 
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What glucometer are you all using as well? I use the alpha trak 2 meter but strips are now over $50 for a pack of 50. I saw the Reli On meter is very affordable. Has this been accurate with your cat?
 
Our dosing methods were designed with human meters in mind. And it wasn't that long ago (like when I started) that no one used pet meters because they weren't readily available. So people here have been using human meters for ages. They are perfectly OK to use and what people are used to anyway.
 
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